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Effectiveness of a targeted exercise intervention in reversing older people's mild balance dysfunction: a randomized controlled trial
Yang XJ, Hill K, Moore K, Williams S, Dowson L, Borschmann K, Simpson JA, Dharmage SC
Physical Therapy 2012 Jan;92(1):24-37
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Previous research has mainly targeted older people with high risk of falling. The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored. OBJECTIVE: This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematically screened as having mild balance dysfunction. DESIGN: This was a community-based, randomized controlled trial with assessors blinded to group allocation. PARTICIPANTS: Study participants were older people who reported concerns about their balance but remained community ambulant (n = 225). After a comprehensive balance assessment, those classified as having mild balance dysfunction (n = 165) were randomized into the trial. INTERVENTION: Participants in the intervention group (n = 83) received a 6-month physical therapist-prescribed balance and strength home exercise program, based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. Participants in the control group (n = 82) continued with their usual activities. OUTCOME MEASURES: Laboratory and clinical measures of balance, mobility, and strength were assessed at baseline and at a 6-month reassessment. RESULTS: After 6 months, the intervention group (n = 59) significantly improved relative to the control group (n = 62) for: the Functional Reach Test (mean difference 2.95 cm, 95% confidence interval (CI) 1.75 to 4.15), the Step Test (2.10 steps/15 seconds, 95% CI 1.17 to 3.02), hip abductor strength (0.02, 95% CI 0.01 to 0.03), and gait step width (2.17 cm, 95% CI 1.23 to 3.11). There were nonsignificant trends for improvement on most other measures. Fourteen participants in the intervention group (23.7%) achieved balance performance within the normative range following the exercise program, compared with 3 participants (4.8%) in the control group. LIMITATIONS: Loss to follow-up (26.6%) was slightly higher than in some similar studies but was unlikely to have biased the results. CONCLUSIONS: A physical therapist-prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment.

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